2002 Award for Excellence in Program Innovation

The Archstone Foundation Award for Excellence in Program Innovation was created in conjunction with the Gerontological Health Section of the American Public Health Association, and was established to recognize the best practice models in Gerontology and Geriatrics. Emphasis is given to those innovative programs that have effectively linked academic theory with applied practice in the field of public health and aging.

This year we are pleased to announce the winner of the Archstone Foundation Award for Excellence in Program Innovation as follows:

Winner of the top honor

Kinship Support Network, San Francisco, California

The Kinship Support Network was the nation's first comprehensive, public-private partnership to support older persons who are raising their relatives' children as an alternative to foster care. Launched in 1993, this program model has been replicated across California and disseminated nationwide. The program has been documented to help elderly grandmother caregivers, predominantly African American, to improve health and mental health status during their participation.

Program Design Nationwide, 3.5 million grandparents are raising their grandchildren - all told, these grandparents are raising more than 5% of all American youth. Here in San Francisco, relative caregivers are raising one in every six youth. The typical caregiver is a 60-year-old grandmother, raising children who have lost their parents due to abuse, neglect, substance abuse, or incarceration. Prior to 1993, when the Kinship Support Network was launched, there was no comprehensive public-private partnership to assess and respond to the needs of these generous but overburdened elders.

Grandparent caregivers have stepped forward to raise children at a time in life when many of us look forward to retirement. They know that the safe home of a loving relative is often the best place for an abused or neglected child to heal. However, poverty, poor health, and social isolation threaten aging caregivers' well-being and that of the children in their care. Edgewood's research has shown that grandmother caregivers who enroll in our Kinship Support Network have poorer health and mental health than other women their age. Reports from the US Census Bureau confirm that the burdens of poverty and poor health are shared by grandmother caregivers nationwide.

Edgewood created the Kinship Support Network as an innovative way to help these elderly caregivers. Our program matches relative caregivers with peer mentors, support groups, and comprehensive whole-family services. Families are served within our private agency, allowing them to bypass public welfare systems and maintain their dignity. When possible, we hire program graduates and other caregivers (often times seniors) as program staff. All together, elderly caregivers can sign up for peer case management, grandparent support groups, respite care, emergency food or housing assistance, mental health counseling, or health care services. They can also find parenting education, after school tutoring, and enriching activities for the children in their care. Services are now available in English, Spanish, Cantonese, Mandarin, Vietnamese, and Tagalog. Last year, we served about 250 elderly caregivers.

Documented Outcomes and Benefits of the Program

When the Kinship Support Network program was created, Edgewood simultaneously founded the Institute for the Study of Community-Based Services (Donald Cohon, Ph.D., Director). The Institute was charged with conducting formal research to document relative caregivers' needs and assess the program's outcomes - filling a national knowledge gap on this long-hidden population.

Since then, the Institute has conducted several longitudinal studies and has partnered with researchers at the University of California at Berkeley, which gathers statewide data on kin caregiving. This research has documented three significant, measurable outcomes:

Elderly grandmother caregivers in the program significantly improved their health and mental health, as measured by pre-post tests using the SF-36 Health Survey (Ware 1993). In contrast, elderly female caregivers enrolled only in the public child welfare system showed stable or declining health and mental health during this same time period. (Cohon, D., Hines, L., Cooper, A. B., Packman, W. & Siggins, E. (2000). Stuart Foundation Final Report July 28 2000. San Francisco, Edgewood Center for Children and Families, Institute for the Study of Community-Based Services.)

Participating caregivers had reduced family needs in 30 out of 31 areas after participating in the program, as measured by pre-post tests using the Family Needs Scale (adapted 9/1995 by D. Cohon from Dunst, Trivette & Deal 1988). (Ibid. 2001)

Children in the program improved their health, mental health, social competencies, and school competencies. In addition, they have significantly fewer problems with anxiety/depression, withdrawal, sleeping, or interpersonal issues. These changes were measured by pre-post tests using the CHQ-PF50 (Landgraf, Abetz & Ware 1996) and Child Behavior Checklist/4-18 (CBCL) (Achenbach 1991). (Cohon, D., Brown, S., Wheeler, R. & Cooper, B. (2001). Office of Criminal Justice Planning Final Report Abuse Reactive African American Kinship Youth Project November 2001. San Francisco, Edgewood Center for Children and Families, Institute for the Study of Community-Based Services.)

The Kinship Support Network has continually linked these research findings to program practice and innovations. For example, one of the Institute's earliest studies found that elderly grandmother caregivers in our program had poorer health and mental health than other women their age by comparing SF-36 Health Survey scale scores with national norms. This finding led Edgewood to add a "Kinship Health Team" to the program model.

Replication Potential and Dissemination Plans

Edgewood has replicated our program in two other cities, East Palo Alto and South San Francisco. The program is also being replicated across California with funding from the state legislature; already 13 California counties have stepped up to the plate to form local Kinship Support Networks with Edgewood's technical assistance. Finally, the Kinship Support Network has been recognized as a national model and has been shared in several other states. We sponsored the first National Kinship Care Conference in 1997 along with AARP, Child Welfare League of America, and Generations United, and a regional follow-up conference in 2000. Edgewood takes an active role in these replication activities and in disseminating research findings nationwide. We have produced a Kinship Operations Manual, Staff Training Manual, Advocacy Video, Research Fact Sheets, and brochures, which together can help any community plan and implement new services for elderly caregivers. Edgewood also provides group and one-on-one technical assistance to communities launching their own kinship programs. Funding, Partnerships, and Collaboration The Kinship Support Network is funded by a diverse blend of public contracts and private donations. We receive funds from our county Office on the Aging, mental health agency, child welfare department, and children's services department. We also seek foundation grants, donations, and volunteer support. The Kinship Support Network partners formally and informally with many other community agencies to avoid service gaps and overlaps. These partners include the Foster Grandparents Program, Asian Perinatal Advocates, schools, community centers, churches, and the local community college. The county has also co-located social workers on-site at our kinship centers to facilitate collaboration and program referrals. The Kinship Support Network is an innovative approach that has improved health and quality of life for hundreds of older people, and has raised the country's awareness of aging caregivers' essential role in our society. Indeed, this population of more than 3.5 million elders was virtually ignored by public and private agencies until the late 1990s—despite their selfless contributions to raising some of our country's most vulnerable youth. Thanks to the Kinship Support Network and other supporters, grandparent caregivers are no longer a forgotten part of our society.

The University of Arizona Elder Rehab by Students Program, Tucson, Arizona

We received 35 nominations this year, all of which truly excelled in program innovation. It is our hope that these model programs can be replicated in an effort to enhance services to the aging population in the United States.